Breast cancer is the overall leading malignancy in Hawaii and the leading cause of cancer-related death in Hawaii's multi-ethnic women. Certain minorities living in Hawaii have among the worst breast cancer mortality and survival in the United States. Although proportionally more advanced disease at diagnosis may contribute to these findings, recent studies suggest that therapy-related factors such as not receiving the most effective available treatments are a major cause. The purpose of this Minority Enhancement Award proposal is to promote, at the University of Hawaii institutional level, the involvement of Hawaii's high-risk minorities with breast cancer in treatment research. The proposal focuses on the development of novel treatment protocols which assure access to state-of-the-art treatment and do not have the eligibility restrictions of national cooperative group protocols. National group studies are currently available for all stages of breast cancer, but exclude about 70% of Hawaii's patients from participation.on the basis of performance status, age, comorbidity or other conditions. Specific aims of the proposal are to: (1) develop and assess the performance of new protocol-based treatments without ineligibility criteria referred to as "non-restrictive treatment protocols" for Hawaii's minority women with breast cancer; (2) develop a case finding system to identify all newly diagnosed breast cancer patients and their continuing care physicians 50 that they may be offered the opportunity to participate in protocol-based treatments; and (3) assess reasons why physicians and patients decline participation in protocol-based treatments. Patient outcome variables to be measured include reasons for protocol deviations, treatment toxicities and whether or not treatment was delivered as planned. Grades of toxicity, treatment interruptions, dose modifications and quality of life measures will document treatment tolerance. Measures of tumor response, time to tumor progression (treatment failure), survival and quality of life improvement will document treatment efficacy. Predictors will include age, performance status, comorbidity, ethnicity, insurance status, and distance from residence to cancer treatment site. The proposal is the first step towards a long-term objective which is to reduce the disproportional adverse mortality and morbidity of Hawaii's minorities with breast cancer through increasing their participation in appropriate treatment approaches.